Inspection on 18/05/05 for Blyth House

This inspection was carried out on 18th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Blyth House 16/04/09

Blyth House 21/05/08

Blyth House 18/08/06

Blyth House 29/10/05

Blyth House 21/12/04

Blyth House 24/08/04

Blyth House 16/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Blyth House 16 Blyth Road Bromley Kent BR1 3RX Lead Inspector Wendy Owen Unannounced 18 May 2005 00:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Blyth House Address 16 Blyth Road Bromley Kent BR1 3RX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 460 3070 Chislehurst Care Ltd Rhona Robinson CRH 23 Category(ies) of OP 23 registration, with number of places Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 21/12/04 Brief Description of the Service: Blyth House is a twenty-three bedded facility, providing nursing care for service users in the category of Older Persons. The home has been registered to the current provider since September 2002. The home was previously registered under the Registered Homes Act 1984. The premises have been adapted and is purpose built. It has bedroom accommodation on the two floors. Communal areas are located on the ground floor. There are eight double bedrooms and seven single. There is a garden to the rear of the building and parking to the front of the building. The home does not have full disabled access. The top floor of the building is used as staff accommodation and is therefore not part of the registered premises.The home operates with qualified nurses and care assistants throughout the twenty-four hour period. The home is supported by GP services and specialist health provision, such as the Community Psychiatric Nurse. Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day. The inspector was accompanied by a Pharmacy Inspector, who undertook an inspection of the medication procedures. During the course of the inspection, the inspector spoke to two visitors; five residents; one member of nursing staff and the manager. Residents’ and staff records were also viewed. A full audit of the medication procedures was also undertaken. What the service does well: What has improved since the last inspection? Care plans and risk assessments have improved slightly since the last inspection, with some detailed information recorded, regarding the individual’s needs, although more consistency is required. Individual contracts have been developed for each resident to ensure they or their representatives, are fully aware of their rights and what they can expect from the home. Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4 & 5 The assessment procedures, whilst adequate, was at times limited and may therefore not provide staff with comprehensive information in order to meet resident’s needs. The home has the systems and procedures in place to meet the needs of the residents. Contracts provide sufficient information to ensure residents are aware of what they can expect from the care home. EVIDENCE: Two visitors spoken to visited the homes on behalf of the family member before making a decision for their relative’s admission. Assessments had been undertaken; one had a care manager’s assessment and both had assessments completed by the home. These covered many of the areas but information was, at times, limited and in some cases, not signed or dated. Therefore there is no idea as to how current the information is. There was no indication that the home had attempted to gather information from other professionals, where there was no care manager assessment. This would help support the home’s own assessment to ensure detailed information is received. The manager felt that this would be beneficial. (See requirement 1) Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 9 Feedback from visitors and residents provided positive comments on the quality of care in the home. One relative commented on how safe their relative felt in the home, whilst a resident said that they were a “a happy bunny” and staff were “great”. Contracts are now issued between the home and individual. These contained the detail required which provides important information about their stay. For example: what they can expect and their rights. However, the home gives only seven days notice in respect of non- payment of fees. This appears unreasonable. This may not be what the provider intended and therefore may require rephrasing or elaboration. (See recommendation 1) Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 There had been some improvement in the care planning documentation since the last inspection and there is evidence that health needs are being adequately met. However, the documentation did not always reflect the actual care required. This leaves residents potentially at risk with staff not always aware of the current needs. Residents are treated with respect and dignity and privacy is respected. Medication practices need improvement to ensure the residents’ health is adequately promoted. EVIDENCE: Care plans had improved since the last inspection. The care plans viewed included details from the assessments and, in some areas the information was very detailed. However, there is still limited information on social and leisure interests. This may reflect the importance, the home attaches to this. The care plans do not always reflect the care provided. For example; two care plans provided information on residents’ personal care needs. However, this did not match with other records and actual care provided and agreed by the resident. In another case the resident’s nutritional needs were not fully recorded on the care plan. (See requirement 2) Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 11 Health care records and risk assessments are completed and include pressure care, moving and handling and nutritional assessments. Where a risk is identified, the care plans and actions to be taken to minimise the risks, were not always recorded. In one case an individual with breathing difficulties did not have the full information recorded in some areas of the care plan although was very detailed in other areas. In another, the pressure care risk assessment identified a medium risk but there were no further details of the actions the home was taking to minimise the risk. (See requirement 3) There was evidence of health needs being met with regular visits from the GP and other health professionals. However, the recording of these visits were inconsistent. Residents and visitors spoken to felt that their family members needs were being well met and were well cared for in this area. Observations and discussions with a number of individuals provided good evidence that privacy and dignity were respected. Although, one resident said their door was always open and their room felt like a “bus shelter” at times. Therefore there were times when peace and quiet were needed, with the door closed. The homes policies and procedures relating to medicines needing reviewing and updating in line with current practice in the home. The homely remedies list did not include indications. The self administration policy did not include details of risk assessment. The drug error policy did not include completion of regulation 37 forms. There were no policies and procedures for receiving medicines, storage of medicines, medicines for residents on leave and use of the monitored dosage system. Records of receipt of medicines were made on MAR charts but quantities carried forward were not noted therefore for medicines not packed in MDS it was impossible to check whether doses had been administered as signed for. Some residents prescribed many different medicines had more than one MAR chart but this was not always clearly marked, and only the first MAR chart was visible in the folder. Some medicines had been discontinued but had not been crossed off the MAR chart. There were gaps in administration records for one resident for Monday where doses had been given but not signed. Conversely, two medicines had been signed as given, but the doses were still in the monitored dosage system. One “when required” medicine did not have complete instructions. Storage facilities for medicines were generally good. However, internal and external medicines were not kept separately in the medicine cupboard. The temperature of the refrigerator was monitored, but the minimum and maximum temperatures were not recorded. The acceptable temperature range quoted was incorrect. The medicine room contained a sink but this was not Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 12 working. The home used the Boots monitored dosage system which appeared to be working well. However, for medicines that were not in this system, it was impossible to check administration records as quantities carried forward from the previous month were not recorded. Homely remedies and calogen liquid were not dated when opened. The oxygen cylinder was not kept in a trolley. Qualified staff had trained carers to administer creams and ointments but this was not documented. Medication was reviewed by the GP when required, but there was no formal system for prompting this review at the required intervals. (See requirements) Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 Activities in the home are adequate and routines appear to meet their needs. Staff interaction is limited at times, due to the tasks, required to be undertaken. This leaves some residents without a valuable source of communication and the opportunity for an improved feeling of well-being. Visitors are welcomed into the home giving the home a warm, friendly and open feeling promoting an over sense of well-being. The evidence suggests that the food provided is good with residents provided with nutritious food in an environment of their choosing. EVIDENCE: There is some evidence that the home has tried to improve on the activities provided within the home and the actual recording of activities undertaken had improved, in a small way. One resident said prior to coming into the home they had watched quite a lot of TV and missed having one in their room. This should be explored. (See recommendation 2) Residents and visitors expressed a satisfaction with the routines within the home, although for some, more time for discussions and chatting with staff or residents with similar capabilities, would improve their quality of life in the home. (See recommendation 2) Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 14 Activities are scheduled for 18 hours per week, with some flexibility on the days the activity co-ordinator works. Not all residents wished to join in and those spoken to said this was their choice. It was positive to note that entertainment had been arranged for that afternoon. However, not all residents wished to attend, staff had asked. The home has a visitors’ policy which states residents welcome visitors between 10-6.00pm. However, there is no evidence that this was a decision made by the residents nor was the manager able to explain this. The manager stated that the policy did not reflect the home’s approach to visiting and visitors spoken to confirmed this. It would be wise to amend the policy to reflect the more open approach. Residents spoke to said that they make choices on what to wear, what they wished to eat and what time to go to bed etc. All residents spoken to said, that the food was good and that there was plenty. One resident said: “Chef does give us lovely dinners”. The lunch- time meal was not observed on this occasion but feedback showed that there were choices and alternatives on offer, should the resident not want the menu choices. Residents can chose to eat in own rooms, if they prefer, or in dining room, it is quite flexible. Hot and cold refreshments were served throughout the day. One area which could be improved upon, is where residents require more fortification in their foods. (See recommendation 3) Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Adequate procedures were in place to ensure complaints were managed and to protect residents from abuse. Residents and visitors felt their concerns would be listened to and acted upon. EVIDENCE: The home has a complaints procedure on display which needs amending slightly, to show timescales for investigation of complaints. The manager has developed a new form for the recording of any formal complaints which ensures full details and actions taken are recorded. There have been no complaints recorded since the last inspection. Residents and visitors spoken to said that the would not have any problem with raising concerns with the manager and felt that they would be listened to and whenever appropriate their concerns addressed and acted upon. Residents and visitors appeared relaxed and comfortable in the home. Adult protection was not inspected fully on this occasion. However, procedures are in place and inspector is aware that there have been no adult protection incidents in the home. Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not inspected on this occasion. EVIDENCE: Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 The staff team had the skills, support and training to meet the resident’s needs. However, recruitment procedures, whilst adequate, are not robust enough to ensure the residents are fully protected EVIDENCE: The staffing rosters identified the appropriate number of qualified nursing staff, care, administrative and ancillary staff. The care staff also provide the required mix of senior and general care staff. Feedback from residents and relatives spoken to was good, with staff being kind and caring. One resident stating that “ care staff are absolutely fantastic” and one visitor stating that their parent felt safe and secure in the home. Recruitment procedures are not robust enough and require some improvement. There is no record of POVA first checks and Criminal Records Bureau checks were not in place for the two file viewed. The manager is not following the updated regulations to ensure the safety of residents, prior to the required checks being received. (See requirement 5) Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33 & 38 The manager presented as running the home in an open and inclusive manner. With the appropriate skills, experience and qualifications to ensure the safety of residents. Records, policies and procedures showed attention was given to ensuring the safety of residents and others. However, the monitoring and reviewing of the systems in place, to ensure care is continually improved upon and meets residents needs. require improvement. EVIDENCE: There health and safety procedures were satisfactory, with the exception of the outstanding requirement from the last inspection, regarding the need for individual fire risk assessments. (See requirement 6) There have also been issues with burglaries recently. This is being dealt with and managed appropriately, by the provider. It is hoped that the actions being taken will minimise these risks in the future. The monitoring procedures, internally and externally, require some improvement, to ensure the systems in place are being implemented by the Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 19 staff. There has been only Regulation 26 visit made by the provider in the last year and no internal audits recorded. Relatives and residents spoken were unaware of any consultations or requests for feedback from the provider. It is important that the manager and provider understand the need for such reviews and self –audits, in order that they are able to make a self-assessment and identify actions required to improve the quality of the care. (See requirement 7) Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 2 2 x x x x 2 Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14 Requirement The registered person must assess fully the needs of residents, before admission into the home and appropriate recordings maintained. The registered person must ensure that care plans reflect the needs of residents The registered person must ensure, where risks have been identified, there is a record of the actions the home is taking to minimise the risks. Pleas see attached pharmacy requirements regarding requirements. The registered person must ensure that recruitment procedures are more robust in order that residnets are adequately protected. The registered person must ensure individual risk assessment are in place to ensure residnets are protected in the event of a fire. Timescale expired 1/02/05. The registered person must ensure that moniotring of the homes procedures takes place Version 1.30 Timescale for action 1/07/05 2. 3. 7 8 15 13 01/07/05 01/07/05 4. 9 13 5. 29 17 & 19 please see pharmacy requiremen ts. 01/07/05 6. 38 13 & 23 01/07/05 7. 33 26 01/07/05 Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Page 22 regularly. This must inlcude the undertaking of the required regulation 26 visits and a system for the internal autiing of practices. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 2 12 15 Good Practice Recommendations The registered provider should amend the notice period for non-payment of fees, in the homes contract, to ensure this is fair and reasonalbe to residents. The registered person should ensure individuals need are discussed, such as the provision of a TV or radio in room. The registered person should ensure that those residents with poor nutrition are provided with adequate food supplments and food fortification. Blyth House G51G01s37404BlythHousev215253.18.05.05stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection Riverhouse 1 Maidstone Road Sidcup Kent BR1 3RX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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